Case Report: Trilogy of Anomalies

  • Nauman Naseer
  • Noor Anjum
  • Awais Hussain Kazim
Keywords: : left anterior descending artery (LAD), right coronary artery (RCA), intra myocardial bridging, fistulous communication


Abstract : Congenital anomalies is interesting in the sense that many patients can manifest with symptoms in childhood while others may remain asymptomatic or with unusal symotoms and anomalies are diagnosed accidently in adulthood. We are sharing this case of 66 year old female who presented to us symptoms suggestive of cardiac ischemia and three anomalies which might be the contributing factor in this patient.  Anomalous right coronary artery originating from the left anterior descending artery, left anterior descending artery intra myocardial bridging and a fistulous communication of the septal perforators with the left ventricle.

Methods and Materials : Right radial area was sterilized  with pyodine liquid and draped. The subcutaneous tissue was numbed with 2 ml of 2% lidocaine injection. The right radial artery vascular access was taken via 5 Fr sheath. Guide catheters JL  3.5 and JR 4.0 used to engage the left main and right coronary artery respectively. . This case has been reviewed and approved by the IRB (Institution review board) of Bahria International Hospital, Lahore. The literature for discussion was reviewed from various articles from Pub Med and internet search engines before submission.     

Conclusions : The anomalous origin of the right coronary artery from the left anterior descending artery is a unusual coronary anomaly. Congenital anomalies do occur very rarely but what is important is to stratify whether they can pose serious cardiac effects and appropriate measures to be taken beforehand.

How to Cite
Nauman Naseer, Noor Anjum, & Awais Hussain Kazim. (2019). Case Report: Trilogy of Anomalies. Annals of King Edward Medical University, 25(2). Retrieved from
Case Reports

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